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Figure 1. Suicide prevention resources (abc57 News, 2019).
1.1 Topic Introduction
1.2 Health Determinants
Suicide is a serious issue in New Zealand. Suicide rates are an indication of the population's mental health and social wellbeing. Māori male has the highest rates of suicide compared to the non-Māori population (Stats NZ, n.d.).
Colonisation for Māori is not just a past change but a present condition. K Lawson-Te Aho (1998) states colonisation has links to suicide because of the negative impacts it has on the Māori population. Ethnicity can have an impact on how certain groups can be excluded from society, Māori is on the lower social structure due to their ethnicity and this can cause an individual to feel disempowered and put them in an at-risk psychological state. The Māori population have social disadvantages which include poverty, poor housing and overcrowding, high unemployment, and poor education. Additionally, this group is more than likely to be part of families where abuse, violence, and poor mental and physical health impacts their lives (Collings & Hirini, 2005).
All of these factors combined will affect individuals and communities health. Lower levels of education are linked to poor health and can reduce self-confidence. Whereas, physical environments, such as unsafe homes contribute to unhealthy living. An individuals health and well being can also be affected if there is no support from whānau, friends, and communities, or if traditions and cultural beliefs and customs are disregarded(World Health Organisation, 2019).
1.3 Local Campaign: Into the Light - ASAP
Aroha Suicide Awareness Prevention is a community-led organisation run by Tamati Williams, Irene Walker, Hinenui Cooper, Wahia Walker-Poroa and DeLanie Ututaonga. Originally, Aroha Suicide Awareness Prevention was created by Tamati Williams after the death of Wahia Walker-Poroa’s sister, Phoenix (Hunter, 2017). In addition to losing her sister, Walker-Poroa also lost an aunt in the same month to suicide, further sparking the need to address the issue within the Tauranga community (Clarke, 2017). Clarke (2017), states that Wahia Walker-Poroa and her whānau wanted to address suicide prevention and awareness, therefore, the campaign was established in the form of a music concert known as Into the Light - ASAP. The campaign, held at Queen Elizabeth Youth Centre, set out to open up the discussion around suicide, raising the awareness. The main focus of Into the Light - ASAP is to inspire one or more person’s life through the concert which means the campaign will be worth it (Hunter, 2017). Miss Walker-Poroa goes on to discuss that relationships, job loss, self-love, self-confidence and financial stress are triggers for suicide and may be reasons why people do not open up to the discussion (Hunter, 2017). A member of parliament, Te Ururoa Flavell, who attended the campaign, discussed that not keeping silent or hiding the issue and discussing solutions would be beneficial to the community if strategies were created within the community itself, which the campaign has opened up for deliberation (Clarke, 2017). Along with the live entertainment, the campaign also included a kids zone, food stores, support networks, service providers and motivational speakers. The support networks, service providers and motivational speakers were there to offer places that whānau may go to get help, as well as, sharing what they do (Hunter, 2017). The campaign also gave out balloons to 250 people, in which they could write names on them before they were released at midday to open the campaign. To close out the campaign lanterns were released in the evening (Hunter, 2017).
1.4 National Initiative: Lifekeepers
LifeKeepers is the national suicide prevention training programme, created especially for New Zealand communities. It was officially launched by Le Va in South Auckland in the year of September 2017. People can register for a training workshop at www.lifekeepers.nz. This program is available free of cost to New Zealanders who are 18 years and over. This program is created for those who work in communities or in frontline community roles, such as support workers, sports coaches, emergency service personnel, church leaders, school counsellors, youth workers, Māori wardens, caregivers, Kaumatua and community leaders. Furthermore, this program provides prevention training to their staff such as first aid training, giving people the skills to identify and support those at risk of suicide. Lifekeepers program offers an understanding of suicide risk factors as well as how it can save a life by teaching them the importance of life, strategies for how to have the conversation and ask about suicide, how to respond with confidence. In addition, LifeKeeper is an internationally proven, evidence-based approach with local knowledge and experience, to provide a programme that is community focussed, clinically safe, and culturally responsive (LifeKeepers, 2019). One organisation can not overcome the suicide problem so they are working with other strategic partners such as Te Rau Matatini, Homecare Medical, and Walker Psychology
our Expert Advisory Group, as well as they, are getting collaboration from national suicide prevention organisations such as CASA, Rural Health Alliance Aotearoa New Zealand, Waka Hourua, Skylight, Kia Piki Te Ora, the Mental Health Foundation, and DHBs. The logo of the lifekeepers, the double helix is represented by two strands of flax; a symbol of whanau and positive relationships. The wrap around provides care and protection. The three koru in the LifeKeepers logo express our connection to the past, the present, and the future (see appendix 1.) (LifeKeepers, 2019).
1.5 International Initiative: Gatekeepers
It was estimated in 2002 people lost to suicide worldwide was 877 000. It is evident that it is necessary to develop effective, evidence-based suicide interventions. Most suicide prevention approaches fall into one of two general types: reducing the risk of suicide or seeking referral or therapy for individuals at risk of suicide. Even though some suicide prevention programs have been successful, their effect has not lasted for long periods of time. One training program initiative, called Gatekeeping Training, has appeared as a successful initiative for suicide prevention that has now been supported globally (Isaac et al., 2009).
The ‘United Nations’ has suggested that the gatekeeper training be regarded in the application of an efficient suicide prevention approach. This training teaches people to identify people at high risk of suicide and then refer them to therapy. The Gatekeeper training programme was developed because it was established that people at high risk of attempting suicide were more than often not seeking help. Gatekeepers are trained over a timeframe of between two to five days on how to recognize the risk factors that will help to identify these high-risk people and then refer them to the right therapy. People who train as gatekeepers come from all different backgrounds, they consist of people from a variety of field professionals to locals who volunteer. The training of gatekeepers varies from country to country, one example of this, in an Australian Aboriginal community the training involved myths, suicide facts, warning signs, and referral strategies based on Aboriginal culture (Isaac et al., 2009).
2.0 Critical Analysis
2.1 Local Initiative: Into the Light - ASAP
Into the Light - ASAP, unlike Lifekeepers and Gatekeepers, is a community-led campaign. This campaign also has a strong focus on suicide prevention in Tauranga for the Māori community, where as both Lifekeepers and Gatekeepers focus on entire populations. Another uniqueness of Into the Light - ASAP is its presentation in the form of a concert, which created an environment best suited for the particular community.
Into the Light - ASAP has highlighted several strengths throughout its completion. This can further be backed up by applying Te Pae Māhutonga, a model for health promotion in Māori communities. Created by Mason Durie, Te Pae Māhutonga aligns with the constellation of stars known as the Southern Cross and is used for a symbolic chart for mental health promotion by outlining the dimensions (Durie, 2011). With that being said, the dimensions of healthy lifestyles (toiora), participation in society (te oranga), leadership (ngā manukura) and autonomy (te mana whakahaere) are evident as strengths within the campaign. Firstly, toiora and te oranga can be seen throughout the promotion of education surrounding suicide and where whānau may go to seek help. Durie (1999) mentions that toiora and te oranga can be created by protecting people from self-harm by utilizing targeted intervention, in this case by providing whānau with education to make decisions surrounding their mental health outcomes. Secondly, as Into the Light - ASAP is a community-led campaign, ngā manukura is obvious. Durie (1999), states that health promotion will be effective if it is lead by local individuals and communication lines are open between the leaders and whānau. Lastly, mana whakahaere is noticeable through the types of education provided to whānau in order for them to take control of their situation. Durie (1999), defines te mana whakahaere as being an important aspect of overall health due to people being in control and having the ability to be able to self govern. As it can be seen four dimensions of Te Pae Māhutonga are seen to be strengths in the health promotion for the Into the Light - ASAP.
While Into the Light - ASAP has several strengths there are also weaknesses. Once again, in the application of Te Pae Māhutonga environment protection (waiora) and access to te ao Māori (mauriora) can be seen to prevent the campaign from creating optimal results. The release of the balloons is seen as a weakness as when they come down they will infect Papatūānuku. Durie (1999) describes health promotion campaigns should be taking the environment into consideration with planning, however, this is not the case with Into the Light - ASAP. He also continues to define the relationship between people and environmental protection as being a key aspect of promoting healthy lifestyles (Durie, 1999). In addition, mauriora has not been fully encompassed as the campaign was held at Queen Elizabeth Youth Centre. According to Durie (1999), the event would be better held at the local marae, to further embody mauriora. Cultural identity is detrimental to Māori health, therefore, moving the event to a marae allows them to experience the Māori world (Durie, 1999).
Based on the weakness discussed of the campaign, recommendations can be made. Perhaps for future events instead of releasing balloons to commemorate those lost, it would be environmentally beneficial to plant flowers in a community garden. For Māori, community gardens are often located near a marae or on ancestry ground, this encompasses both waiora and mauriora (Hond, Ratima & Edwards, 2019). Hond, Ratima and Edwards (2019), describe Māori community gardens or māra as being vital to the community and aiding in healthy sustainable practice. This further enhances cultural identity and environmental protection which are two important aspects of achieving positive Māori health outcomes.
2.2 National Initiative: Lifekeepers
Lifekeepers is a free national suicide prevention program which helps people to prevent suicide. Lifekeepers also encourages their worker by nominated for their outstanding contribution to preventing suicide in their community. According to the study, it helps community people to work with them which creates positive energy in the mind of the community people. Moreover, the suicide rate has decreased after the implementation of life keeper. Lifekeepers also important because it increases awareness and confidence among the community people. Lifekeepers is a good network of counsellors which help to give better knowledge about yourself such as life challenges and interpersonal relationships. Another strength of the life keeper is short term and long term goal. The short term goal means to raise the number of skills people for controlling the people who are the risk of suicide. The long term goal improves network among the community (Bradbury, 2019).
Although Lifekeepers training is a good combination of skills. According to the study, it has some weakness such as suicide prevention training. They provide little information about suicide so they are unaware of the strong emphasis on roleplay, active participation in group
discussions, and the likelihood of personal disclosure. Another weakness is the lack of availability of effective services for supporting people at risk of suicide such as first aid which is highly useful at the risk of suicide. Moreover, the opportunities for networking and learning about effective services are not sufficiently structured because sometimes the trainers do not ask about the educational status of the applicant (Koroi, 2015).
It would be useful for trainees to know that the program is highly participatory and encourages personal disclosure around trainees’ experiences related to suicide. This advice is especially important if the trainee is being required to undertake the program as part of professional development. It is also recommended the importance of first aid programs which help to control incidence. Moreover, the outcomes information should be recorded at the national level which will be proved more beneficial for upcoming strategies. Many of argues that the training period is small and it should be extended long as someone can deal in a better way in the communities (Koroi, 2015-b).
2.3 International Initiative: Gatekeeper Training
When comparing the International Initiative Gatekeeper training against local and national initiatives in New Zealand, the national initiative Lifekeepers is a fresh, new gatekeeping training. New Zealanders did not like the gatekeepers name, so it was decided to change it to lifekeepers. All training is similar to gatekeeping training. Both training programs is to equip trainers with knowledge in preventing suicide (Lifekeepers, 2019). The local initiative is different compared to both national and international as it is focused to campaign out in the community to raise more awareness of suicide, furthermore, it is focused more on the Māori population, whereas, the national and local initiatives are focused on all populations and cultures.
Gatekeeper training results showed important rises in self-assessed suicide knowledge, resource consciousness, faith in suicide discussion, trust in reacting and communicating with a suicidal person, comfort in speaking about suicide, and the probability of someone asking about suicide. Studies also showed that where gatekeeping training was conducted that there were fewer suicide fatalities after the execution of the training than in previous periods.
These results have shown there is an increased self-efficacy following training in suicide prevention and the positive changes in the knowledge of suicide and intervention self-efficacy of the participants. (Ayer, Burnette, & Ramchand, 2015).
Overall, studies indicate that the beneficial impacts are seen immediately after training often decline after a certain time. At a three month follow up after training, participants that had completed the gatekeeper training were concerned that no further training was added to keep their skills up and additional skills that were required on updated available resources, listening skills, how to voice concerns and to persuade someone at risk to get help. While gatekeeper training has been conceived as a successful alternative to a significant policy problem, its evidence base may not be as powerful as its attraction, as it does not concentrate on a particular environment or population (Lipson, 2014).
The method, influence, and outcomes of gatekeeper training need to be carefully monitored and also data kept to see if the program is making a difference. Trainers who have completed the gatekeeper training have also stated that two days of training is not enough, and more days of training is required. Moreover, after three months, it was felt that there were inadequate resources and evaluations to see if more training was needed (Takahashi et al., n.d.).
3.0 Our Initiative: Kaioa (Live) Mataroa (Life)
The foundation upon which our initiative has been developed is from the tool kit developed by World Health Organisation (WHO), it is aimed specifically as a community engagement toolkit to prevent suicide, our group will be using this toolkit in a Māori perspective as our focus is on this population. The components of Kaioa Mataroa are as follows:
Leadership (hautūtanga) - strong leadership is the backbone of any successful program of suicide prevention. We would need to have key stakeholders involved that share a passion for reducing suicide. This committee could consist of government and non-government agencies, whānau, iwi, hapū, community leaders, and public health workers. (Suicide Prevention Resource Center, 2019).
Intervention (wāhi ngaro) - is a combination of program strategies that will produce behaviour changes that will be effective in reducing suicide rates among Māori youth and have a long term effect.
Vision (tūruapō) - a vision is essential to introduce new innovations and testing new delivery platforms. It is also needed for financing and resourcing planning to access any funding opportunities and partnerships.
Evaluation (aromātai) - to ensure that our suicide prevention goals are reaching the desired impact, strategies and interventions must be monitored and evaluated regularly.
Less Means (iti iho tikanga) - restriction needs to made to reduce the access to means that youth are using to attempt suicide eg: pesticides, firearms, and drugs.
Interaction with the media (te tau nekeneke me to awhina) - getting media to advertise in a positive way to raise awareness about suicide and prevention, and removing the stigma around Māori suicide
Form the young (hanga i te taitamariki) - achieve an effective intervention for young Māori by enhancing young peoples problem solving, coping and life skills.
Early identification (te tautuhi wawe) - have people trained in recognizing risk factors and signs of someone that may be contemplating suicide, if early intervention is done people can get the help they require.
3.2 Target Population
According to the Unicef, the suicide rate in the Maori youth (between 15 and 19) is highest rather than to other groups. According to Dr Stone the suicide rate of Maori youth 1.4 times higher than to other groups. There are much reason for Maori teenage suicide such as due to the family violence, child abuse, child poverty, mood disorders and substance misuse (including alcohol) so the target of this essay is Maori teenagers to decrease the suicide rate and help them to increase their health. Another statistics for the witness of the target population in the year of 2017/18, the total Maori suicide 142 deaths whose highest statistics were first recorded for the 2007/08 year (Illmer, 2017). The target population will be Māori youth at two Tauranga schools. As the high rates of suicide are Māori aged between 15 and 19, the two schools will be Tauranga Boys College and Tauranga Girls College.
As the NZ government has recently introduced the Wellbeing Budget, with a strong emphasis on mental health, funding for the Kaioa Mataroa is obtainable. With the extra $40 million the government is committing to suicide prevention
3.4 Resources and Planning
This section will cover how the group plans on using our intuitive Kaioa Mataroa.
A group or committee that is passionate about reducing suicide rates among Maori youth will be established. This group will consist of local iwi, school representatives, counsellors, and public health workers from Toi te Ora. This group will be responsible for the planning, meeting with schools, arranging training of gatekeepers/lifekeepers to be placed in schools, counselling for suicidal youth, and working with the media to advertise in a positive way to reduce suicide within Māori.
To put an intervention in place at both Tauranga Colleges, a programme needs to be introduced as part of the criteria as a subject that will be taught by a lifekeeper. This will teach students to notice signs of fellow peers that may be contemplating suicide, and it will teach students where to reach out for help, and what help is available. Counsellors at school will also be trained in suicide prevention and recognising at-risk students, and the steps to follow to intervene so as to help reduce suicide rates. The group will also meet with a local marae to organise monthly weekend nohos (stays) for Māori to attend where workshops will be run for youth to help them learn problem-solving skills, coping and life skills, and to lessen the stigma around Maōri suicide. A therapist will also be organised to attend the noho so youth have access to talk freely to them about any issues.
As a lot of youth seem to attempt or contemplate suicide under the influence of drugs or alcohol, this is seen as a means of doing it. The group needs to reduce the means, to do this as part of the programme in school and at the marae nohos, there will be programs also introduced around alcohol and drug consumption, and the effects it has on not just the body but brain also.
The important part of implementing these programmes in schools and also the marae is involving the community and whānau, if youth can see that their community and whānau are involved with reducing suicide, especially within Māori, this will lift the shame and the stigma around reaching out for help. Involving whānau in the marae nohos will not just assist in helping youth but the whānau as a whole, which is an important part of the healing process. According to Mason Durie (2005) having the whānau together working on interventions can reduce risk factors, increase protective factors such as whānau support and positive experiences. Having a therapist at the noho will maximise engagement as it will be based on cultural interactions, Māori communication styles, and tikanga (Durie, 2005).
With the help of Māori role models that have a positive impact on Māori youth, they will work with media to create positive imaging on reaching out for help, this will be done as national campaigns, and ads on television. There are role models such as Mike King, that youth look up to, who themselves have had mental health issues, with sharing their stories on how they overcome their issues with youth this will have a positive impact on youth, showing there is no disgrace as a Māori to reach out for help.
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